The Dark Side of Soft Tissue Injury and Chronic Pain – Part 1
How many times have you been told, “It’s just a soft tissue injury?” This is an uninformed tactic to diminish the seriousness of the whiplash type soft tissue injury. Unfortunately, many injury victims progress to a state of chronic pain. Various research articles have demonstrated that 40% (1) to 89% (2) of patients still experience chronic whiplash related neck pain.
While the process of developing chronic pain after a soft tissue injury can be complicated there are some documented findings that can indicate a poor prognosis for long term pain. One such finding is rapid fat infiltration of the neck muscles.
Fatty Infiltration Of Muscles
According to a study by Elliott et al,(3) the development of fatty infiltration of the small neck muscles evidenced by MRI has been shown to be associated with specific aspects of pain. In their study they found that individuals with a fatty infiltration of 20.5% or higher at 2 weeks post-injury had a sensitivity of 87.5%*and specificity of 92.9%* of predicting the outcome at 3 months.
Essentially, if fatty infiltration is noted as early as 2 weeks post injury, there is significant chance that the patient may develop chronic pain by 3 months.
What Can Be Done
The theory regarding the development of the fatty infiltration is that injury to the small neck muscles (multifidus) causes abnormal movement patterns which in turn, produce weakening of the muscles. Which is then followed by the fat infiltration.
Two treatments that can help slow this process are spinal adjustments and proprioceptive exercises. The basic principle behind these treatments is a stimulation of the muscles causing increased muscle activity and a more normal movement pattern.
*Sensitivity: the ability of a test to correctly identify patients with a disease.
*Specificity: the ability of a test to correctly identify people without the disease.
Dr. Martin graduated from Life Chiropractic College in Atlanta GA, where he earned his Doctor of Chiropractic degree. He is one of only a few board-certified chiropractic orthopedists in the metro St Louis region. He is a Diplomate of the International Academy of Neuromusculoskeletal Medicine. He uses the latest neuroscience research to make the best diagnosis of the cause of your pain as the starting point for your recovery. Since 1984 he has helped many people find relief from chronic pain or helped those injured in accidents recover.
(1) Treleaven J. Dizziness, unsteadiness, visual disturbances, and postural control: implications for the transition to chronic symptoms after a whiplash trauma. Spine (Phila Pa 1976). 2011 Dec 1;36(25 Suppl):S211-7. doi: 10.1097/BRS.0b013e3182387f78. PMID: 22020615.
(2) Park, Donghwi, Kwak, Sang Gyu, and Chang, Min Cheol. ‘Five to Ten-year Prognosis of Whiplash Injury-related Chronic Neck Pain: A Brief Report’. 1 Jan. 2022 : 1 – 5.
(3) Elliott JM, Courtney DM, Rademaker A, Pinto D, Sterling MM, Parrish TB. The Rapid and Progressive Degeneration of the Cervical Multifidus in Whiplash: An MRI Study of Fatty Infiltration. Spine (Phila Pa 1976). 2015 Jun 15;40(12):E694-700. doi: 10.1097/BRS.0000000000000891. PMID: 25785961; PMCID: PMC4466088.